- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $4,897.79 / $11,748.98
| Facility | | $1,380.38 | $4,897.79 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,047.13 / $2,398.83
| Professional | | $912.01 | $1,047.13 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $9,772.37 / $20,892.96
| Facility | | $3,467.37 | $9,772.37 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,318.26 / $2,511.89
| Professional | | $870.96 | $1,318.26 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,090.30 / $7,079.46
| Facility | | $1,737.80 | $3,090.30 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,548.82 / $3,311.31
| Professional | | $954.99 | $1,548.82 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,786.30 / $11,220.18
| Facility | | $1,584.89 | $4,786.30 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,230.27 / $2,290.87
| Professional | | $870.96 | $1,230.27 | $2,290.87 |